Abstract
BackgroundSialorrhea is common in children with neurological disorders and leads to social isolation, aspiration pneumonia and increased caregiver burden. Sialorrhea management includes anticholinergic medications and a variety of surgeries, but these are limited by side effects, recurrence and risks.ObjectiveWe present our method of salivary gland ablation, an interventional radiology treatment for sialorrhea, and report safety and efficacy data from pediatric patients who underwent salivary gland ablation.Materials and methodsSalivary gland ablation uses image-guided sotradecol and ethanol dual-drug injection into the salivary glands. Submandibular and sublingual glands are injected percutaneously using ultrasound. Parotid glands are injected retrograde through Stensen ducts using fluoroscopy. We conducted a retrospective review of the medical records of patients who underwent salivary gland ablation at our institution between 2005 and 2019. Pre- and post-procedure Drooling Frequency and Drooling Severity (DFDS) scale scores were compared and caregiver satisfaction was assessed. We devised two cohorts, one to study patient safety and a subcohort to study clinical efficacy using DFDS scores.ResultsOne hundred and seventy salivary gland ablation procedures were performed in the 99 patients comprising the safety cohort. Of the procedures, 88.8% resulted in no or minimal complications. Respiratory difficulty, temporary nerve palsy and infection represent the majority of the 11.2% of patients who experienced periprocedural complications. There were no complications resulting in permanent sequelae. Twenty-seven patients met our inclusion criteria for the efficacy subcohort with a mean follow-up time of 5.4 years. DFDS at follow-up decreased from a median score of nine to a seven post-procedure (P=0.000018). The proportion of caregivers who were satisfied with the procedure increased as more glands were ablated, which suggests a causal link between the number of glands ablated and the outcome.ConclusionSalivary gland ablation is a safe and effective procedure with the potential for permanent decrease in symptoms related to sialorrhea.
Highlights
Sialorrhea is the unintentional loss of saliva from the mouth, which is normal under the age of 2 years, but is considered abnormal if it persists beyond the age of 4 years [1, 2]
Ninety-nine patients met our inclusion criteria for the safety cohort. These 99 patients underwent a total of 170 salivary gland ablation procedures
Due to the technical simplicity of injecting the submandibular and sublingual glands, which was achieved in all patients, we report only on the technical success of parotid gland treatment
Summary
Sialorrhea is the unintentional loss of saliva from the mouth, which is normal under the age of 2 years, but is considered abnormal if it persists beyond the age of 4 years [1, 2]. Sialorrhea is common in children with a variety of neurological disorders including cerebral palsy [2, 3]. The cause is oral sensorimotor impairment, which manifests as the lack of oral continence and a normal swallow reflex [4]. Anterior spillage of saliva from the mouth, drooling, can lead to dermatitis, perioral infection, hygiene compromise, the need for frequent clothing changes, and damage to toys and other belongings. This increases the burden of caregivers [5]. Sialorrhea is common in children with neurological disorders and leads to social isolation, aspiration pneumonia and increased caregiver burden. Sialorrhea management includes anticholinergic medications and a variety of surgeries, but these are limited by side effects, recurrence and risks
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